What are opioids?
The term “opioid” refers to an entire class of drug that originally derived from poppy plants.
“Opioids” include:
• prescription medications that can be legally prescribed but also have potential for abuse; and
• illegally produced substances that have no accepted medical use.
What are prescription opioids?
Pharmaceutically produced opioids are prescription medications that relieve pain. They reduce the intensity of pain signals reaching the brain and affect those brain areas controlling emotion, which diminishes the effects of a painful stimulus.
Medications that fall within this class include fentanyl, hydrocodone (e.g., Vicodin), oxycodone (e.g., OxyContin, Percocet), morphine (e.g., Kadian, Avinza), codeine, and related drugs.
- Fentanyl is a synthetic (meaning human-made versus found in nature) opioid pain reliever that can come in the form of patches, lozenges, or injection, all of which are used legally in hospital settings or as directed by a doctor to treat severe pain.
- Hydrocodone products are the most commonly prescribed for a variety of painful conditions, including dental and injury-related pain.
- Morphine is often used before and after surgical procedures to alleviate severe pain.
- Codeine is often prescribed for mild pain or other conditions such as coughs.
Prescription opioid drugs have valid medical uses, but they also have a high propensity for misuse/abuse and can be extremely addictive.
Additional Information on Fentanyl
Nationwide, drugs like fentanyl accounted for 77% of teen overdose deaths in 2021. According to the Journal of the American Medical Association, the overdose mortality rate among U.S. adolescents aged 14 to 18 years old rose by 94% between 2019 and 2020. (https://www.usnews.com/news/health-news/articles/2022-04-12/teen-overdose-deaths-have-soared-but-drug-use-hasnt).
The Drug Enforcement Administration reported that 6 out of 10 pills containing fentanyl hold a potentially lethal dose. Over 10 million pills were seized in the first 3 months of 2022, while 300,000 were seized in 2018.
How is the use of heroin and fentanyl related to the misuse of prescription opioids?
The use of painkillers (which can be prescribed and then lead to abuse) and heroin/fentanyl (purchased on the street) have similar effects on the body, producing the same “high.”
Why is it a big deal to use opioids that do not come from a doctor?
The following facts highlight why it is a “big deal” to use and abuse opioids:
- Opioids are highly addictive drugs: Tolerance to opioids develops quickly with regular use so more heroin, fentanyl, etc. is needed to produce the same high. These substances can be injected, snorted/sniffed, or smoked and enter the brain very quickly.
- There is no “cookie cutter” or easily identified user – anyone can become addicted.
- Addiction is painful, powerful, extremely dangerous, and often fatal, and can last a lifetime.
- Health risks to using illicit opioids include fatal overdose, high risk of infections such as HIV/AIDS, collapsed veins, infection of the heart lining and valves, and liver disease.
- Toxic ingredients are usually mixed with heroin or fentanyl and can cause additional health problems.
- When an addict stops using, physical withdrawal symptoms can start in just a few hours. Symptoms include restlessness, insomnia, diarrhea, vomiting, cold flashes with goose bumps, and muscle and bone pain. Major withdrawal symptoms peak between 48 and 72 hours after the last dose and can last up to a week. Sudden withdrawal by heavy users can be fatal.
- Craving opioids can persist for years after drug use stops. It can be triggered by exposure to stress or by people, places, or things associated with drug use. Withdrawal can last a lifetime.
Possible Health Effects
Short-term
Euphoria, warm flushing of skin; dry mouth; heavy feeling in the hands and feet; clouded thinking; alternate wakeful and drowsy states; itching; nausea; vomiting; slowed breathing and heart rate.
Long-term
Collapsed veins; abscesses (swollen tissue with pus); infection of the lining and valves in the heart; constipation and stomach cramps; liver or kidney disease; pneumonia.
Other health-related issues
Pregnancy: miscarriage, low birth weight, neonatal abstinence syndrome, risk of HIV, hepatitis, and other infectious diseases from shared needles.
In combination with alcohol, dangerous slowdown of heart rate and breathing, coma, death.
Withdrawal symptoms
Restlessness, muscle and bone pain, insomnia, diarrhea, vomiting, cold flashes with goose bumps (“cold turkey”), leg movements.
(NIH: National Institute on Drug Abuse from https://nida.nih.gov/research-topics/commonly-used-drugs-charts)
What is an overdose?
An overdose occurs when someone takes too much of a substance. An opioid overdose can cause serious, harmful symptoms, or even death. Opioids slow, and sometimes stops, breathing. If death is not immediate, an overdose on opioids can cause blood pressure drop, heart failure, pulmonary edema, and depressed respiration, all of which can also lead to death.
Overdose can also happen when a user takes more of an opioid than their body is used to –possibly because they were recently in rehab and their tolerance is reduced, or because the drug is stronger than they thought (since heroin and fentanyl bought on the street are illegal, no one regulates their strength, or the substances used to cut them).
Signs of an opioid overdose include slow breathing, blue lips and fingernails, cold damp skin, and shaking. It is critical that someone who is overdosing get immediate medical attention, as the person may die if left untreated. EMS and police personnel have access to drugs such as Narcan, which can counteract the effects of an opioid overdose. However, Narcan is not always effective.
What is the Good Samaritan Law?
Under Code of Virginia § 18.2-251.03, someone who seeks or obtains emergency medical attention for himself or herself or for another individual because of a drug- or alcohol-related overdose in progress may be protected from being convicted for certain possession or intoxication crimes if the person reports an overdose to a firefighter, EMS personnel, or a law enforcement officer (most commonly by calling 911 for emergency medical response).
To be eligible for this “affirmative defense,” the person reporting the overdose must identify themselves as being the one who reported the overdose.
How are opioids classified in the schedules in Virginia’s Drug Control Act?
The Virginia Drug Control Act places controlled substances into six categories called “schedules” depending upon the drug’s acceptable medical use and the drug’s abuse or dependency potential. (Code of Virginia §§ 54.1-3445 through 54.1-3456.1).
The Schedules are described below. Note that all Schedule I drugs (except marijuana pursuant to a valid prescription and for a limited purpose) and many Schedule II drugs are illegal to possess.
